MedNet The Internet: Issues for Community Care Tineke Fitch PhD, Carl Adams PhD and Jim Briggs DPhil Healthcare Computing Group ISCA University of Portsmouth MedNet 2003

2 Introduction Aim and objectives Method Results Discussion Summary Questions Outline

MedNet Community Care (CC): complex, heterogeneous environment, drawing upon different services within health and social care, often involving ad-hoc activity. Provides a key link between patients and other care services. Introduction

MedNet In the UK, provided by the NHS (Health Care) and local authorities (Social Care). NHS: Established 1948 Free care at point of delivery Equity of access 1 million+ employees £42 billion budget (Source: NHS, 2003 “Delivery of Care” ) Community Care

MedNet Groups of professionals from different services, dealing with common patients / clients, sharing similar decision references (life-critical, possibly fatal!) “Collective minds”, “heedful interaction” and “mindful comprehension” (Weick and Roberts, 1993) Community Care

MedNet Decision-making affected by stage of group development: New team start-up Developing distinct entity Well-established. (Stewart, 1991) Community Care

MedNet Information systems failure: inability to meet stakeholder group’s expectations. (Lyytinen and Hirschheim, 1987) However, success or failure viewed differently by interested stakeholders at distinct times. (Connell and Powell, 1992) Particularly relevant to CC, where different groups interact, sometimes on ad-hoc basis. Community Care

MedNet Many nations are investing heavily in technology in care – mobile technologies seem appropriate to support community care and interaction between the various groups involved. NAO suggests UK may be spending less on technology support healthcare than other nations (G7 plus Australia, New Zealand and Sweden) (Source: NAO, 2003a “International Health Comparisons”) Care Spending

MedNet Use of Internet-based mobile support devices in community care - identify: good community practice; related issues and challenges; effect of deployment of devices on interaction between professionals. Aim and objectives

MedNet Semi-structured interviews covering: General Mobile Computing Experience Mobile Computing and Working Practice Mobile Computing in Wider Context Negative Experience of Use Possible Future Use of Mobile Devices Three groups: District Nurses/Health Visitors; Learning Disability; Adult Mental Health. Method

MedNet General Mobile Computing Experience: very little, mainly mobile telephone. Mobile Computing and Working Practice: positive effect for two groups, little effect for the third. Mobile Computing in Wider Context: many opportunities for some CC groups but there are barriers. Negative Experience of Use: none so far. Possible Future Use of Mobile Devices: considerable for some CC groups if barriers can be overcome. Results - Summary

MedNet Issues Focus on job function. Availability of equipment. Appropriateness of equipment. Availability / integration of of notes and records. Security / confidentiality. Working practices / protocols. Standards. Organizational. Politics at national and local levels. A ccess control processes and procedures.

MedNet Any technology or equipment provided needs to support “heedful interaction”. Implications Increased deployment of technology should not lead to deskilling / change focus from patient to device. Features to support security / confidentiality must not have negative impact on patient interaction and / or job satisfaction.

MedNet Availibility of equipment - if not available to all groups, than interaction affected. Implications Appropriateness of equipment, plus proper training, technical and maintenance support. Availability / integration of notes and records - to support interaction; requires new or amended protocols and political will, nationally and locally.

MedNet Security / confidentiality: data storage / user ID. Again, focus and function should not change from patient to device. Implications Development of practices and protocols: these need to be agreed and accepted by all groups; emphasis on “human factors” of a different kind. Standardization poses technical, organizational and political challenges.

MedNet Summary Changes to working practices are required to successfully integrate Internet-enabled technologies into community care but mind shift from patient to device. Political will at national and local levels very powerful - acceptance by stakeholder groups. However - the real challenge is how these new technologies can provide positive impact on stakeholder collaboration to support and enhance heedful interaction.

MedNet Thank You. For further information, please contact Tineke Fitch, Carl Adams or Jim Briggs Healthcare Computing Group ISCA University of Portsmouth MedNet 2003